164 a fairly developed child and gave evidence of no serious defect on inspection. There was no cyanosis nor clubbing of the fingerq, but she became breathless while at play, and perhaps a little cyanosed. There was a well-marked long- continued systolic murmur to be beard, its point of greatest intensity being at the base of the heart to the left of the sternum. The case was shown as one of congenital pulmonary stenosis or of patent ductus arteriosus. Mr. SIDNEY A. BOYD showed a case of Hsemangioma of the Foot. Dr. PARKES WEBER read a paper on a case of Congenital Pulmonary Stenosis, with special consideration of the nature of the secondary blood changes, which is published in full in this issue of THE LANCET, p. 150. SOCIETY OF MEDICAL OFFICERS OF HEALTH. The Relation of Public Healtta to Industrial Diseases. A MEETING of this society was held on Jan. 13th, Dr. W. G. WILLOUGHBY, the President, being in the chair. In the unavoidable absence of Dr. B. A. Whitelegge, a discussion upon the Relation of Public Health to Industrial Diseases was introduced by Mr. W. F. DEARDEN, who said that the excessive mortality from certain diseases which afflicted workpeople engaged in particular industrial pursuits must point to the existence of some method of causation common to each industry con- -cerned, whether or not this be directly or indirectly attributable to the trade process itself. There was one out- side factor, however-viz., alcoholism -which appeared to pick out certain trades in the exercise of its deleterious effects. Workers subjected to excessive heat, as in glass- works and rubber-works, were, on account of the thirst created, very addicted to the use of alcohol and suffered accordingly. The alcoholic tendency of printers, hatters, and shoemakers was well known ; waterproof-cloth spreaders, who were subjected to naphtha fumes, were very rapidly affected by alcohol, and it was suicidal for workers in lead to indulge in the habit. The direct influence of trade pro- cesses upon the production of disease was particularly marked in dusty occupations, and could be further illustrated by a reference to the dangerous trade processes scheduled in the Workmen’s Compensation Act. One way in which industry affected public health was the production of a special liability to incapacity and death as the result of accident. In 1909 there were 39,966 accidents investigated by certifying factory surgeons, and of these 946 were fatal. The provisions of the Factory Act referring to safety came quite within the range of public health, including as they did the providing of means for escape from fire and the feneing of dangerous machinery. General sanitary require- ments had reference to cleanliness, proper provision of closet accommodation, air-space, ventilation, temperature, and the drainage of floors where wet processes were carried on, though it appeared strange that there were no obligations as to efficient lighting. The investigations by certifying surgeons of cases of anthrax, plumbism, mercury, phosphorus, or arsenic poisoning contracted in a factory or workshop were of great value, and had resulted in a supply of information which had been of immense service in demonstrating the necessity for supervision of the processes. Although much had been done to improve the lot of the workers since the first Factory Act was passed over a hundred years ago, the factory sanitarian could not yet rest on his oars. On the other hand, the medical officer of health must recognise the influence on the .general health of the community of the ill-effects which kept pace with, and which could not be dissociated from, industrial - occupations. Dr. EDWARD C. SEATON referred to the work of Dr. Whitelegge at the Home Office, and Dr. G. P. BATE con- sidered that one of the most important reforms of recent years was the introduction of the conditional certificate of employment for children. Many children in an indifferent state of health were better if working at a suitable employ- ment than running wild in the street. He pointed to the greater efficiency of inspectors of factories, who were now obliged to have a working knowledge of hygienic conditions. Dr. A. GLEN PARK also spoke with approval of the con- ditional certificates, but regretted that he was not empowered as a certifying surgeon to make a subsequent examination of a child for the purpose of ascertaining whether conditions he had laid down, such as the provision of spectacles, had been carried out. There was no doubt that these certificates had encouraged certifying surgeons to allot suitable work to particular children. Dr. ALFRED GREENWOOD would like to see a closer cooperation between medical officers of health and certifying surgeons, and suggested that the latter should have access to the results of the medical inspections of school children. Mr. F. E. FREMANTLE advocated courses of popular in- struction for workmen in the methods to be employed in preventing accidents, and suggested that models of machinery properly guarded should be placed in public museums. Dr. J. H. KEAY supported this suggestion, and referred to the fact that children who had been examined by a school medical officer upon leaving school were frequently rejected by the certifying surgeon on account of defective eyesight. Dr. E. L. COLLIS urged the importance of medical officers of health taking more interest in conditions of employment in special diseases, and referred with satisfaction to the work in this direction which had been done by Dr. Greenwood and Dr. H. Scurfield. He emphasised the necessity for investigating the invalidity of special industries and considered that danger in occupation was indicated more by invalidity than by mortality. Mr. HERBERT JONES, Dr. A. H. BYGOTT, Dr. SIDNEY DAVIES, Dr. W. BUTLER, and the PRESIDENT also took part in the discussion. SOCIETY FOR THE STUDY OF INEBRIETY. The Influence of Parental Alcoholism on the Physique and Ability of Offspring. THE discussion on this subject, which was held at the winter meeting of this society on Jan. 10th in the rooms of the Medical Society of London, was opened by Dr. T. B. HYSLOP, the President, in an address which we published last week. Dr. Hyslop, it will be seen, emphasised the fact that recent study of the question had greatly increased the sense of its complexity, allowing that he personally under advancing experience was more hesitant than formerly in connecting the mental defects and disorders noted in the offspring with the alcoholism of the parents. The real question to be answered, he said, was, Does parental alcoholism (of a pernicious kind)-apart from parental degeneracy, which, together with a tendency to alcoholism, is hereditable-influence the physique and ability of offspring at any age? He finished his address by saying that the conclu- sions arrived at by the Galton Laboratory School of Eugenics and their critics dealt with part only of the general question at issue, adding, "When further investigations shall have demonstrated the inflaence of parental alcoholism on parental degeneracy, and the combined influence on the physique and ability of offspring, we shall be better able to speak with authority for the guidance of the community." Mrs. SCHARLIEB expressed her general concurrence with Dr. Hyslop’s views, and urged the necessity of keeping an open mind on this question pending the result of fuller inquiry. Sir VICTOR HORSLEY regretted that no representative of the Eugenics Laboratory had thought fit to attend the meeting, in view of Professor Karl Pearson’s recent incur- sion into this question. He referred to the damaging criticisms to which Professor Pearson’s figures had been subjected by the Cambridge economists, and mentioned that as the result of a careful scrutiny of the Edinburgh Charity Organisation Society’s report, utilised in the Eugenics Laboratory inquiry, he hoped in a few days to draw public attention to other grave inaccuracies in Professor Pearson’s statements. 1 He emphasised the fact that in the biometric data no evidence at all was offered to prove the alcoholism of the so-called alcoholic parents. Dr. C. W. SALEEBY pointed out that Professor Pearson himself stated at the outset of his paper that there was a difference in the quality of the stock in the sober and in the drinking parents investigated, and remarked that this fact must vitiate any conclusion as to differences in the quality of the offspring. To test the effect of alcoholism the comparison 1 See Brit. Med. Jour., Jan. 14th, p. 112.
Transcript
164
a fairly developed child and gave evidence of no seriousdefect on inspection. There was no cyanosis nor clubbing ofthe fingerq, but she became breathless while at play, andperhaps a little cyanosed. There was a well-marked long-continued systolic murmur to be beard, its point of greatestintensity being at the base of the heart to the left of thesternum. The case was shown as one of congenital pulmonarystenosis or of patent ductus arteriosus.
Mr. SIDNEY A. BOYD showed a case of Hsemangioma ofthe Foot.
Dr. PARKES WEBER read a paper on a case of CongenitalPulmonary Stenosis, with special consideration of the natureof the secondary blood changes, which is published in full inthis issue of THE LANCET, p. 150.
SOCIETY OF MEDICAL OFFICERS OFHEALTH.
The Relation of Public Healtta to Industrial Diseases.A MEETING of this society was held on Jan. 13th,
Dr. W. G. WILLOUGHBY, the President, being in the chair.In the unavoidable absence of Dr. B. A. Whitelegge, a
discussion upon the Relation of Public Health to IndustrialDiseases was introduced by
Mr. W. F. DEARDEN, who said that the excessive mortalityfrom certain diseases which afflicted workpeople engaged inparticular industrial pursuits must point to the existence ofsome method of causation common to each industry con--cerned, whether or not this be directly or indirectlyattributable to the trade process itself. There was one out-side factor, however-viz., alcoholism -which appeared topick out certain trades in the exercise of its deleteriouseffects. Workers subjected to excessive heat, as in glass-works and rubber-works, were, on account of the thirst
created, very addicted to the use of alcohol and sufferedaccordingly. The alcoholic tendency of printers, hatters,and shoemakers was well known ; waterproof-cloth spreaders,who were subjected to naphtha fumes, were very rapidlyaffected by alcohol, and it was suicidal for workers in leadto indulge in the habit. The direct influence of trade pro-cesses upon the production of disease was particularlymarked in dusty occupations, and could be further illustratedby a reference to the dangerous trade processes scheduled inthe Workmen’s Compensation Act. One way in which
industry affected public health was the production of a
special liability to incapacity and death as the result ofaccident. In 1909 there were 39,966 accidents investigatedby certifying factory surgeons, and of these 946 were fatal.The provisions of the Factory Act referring to safety camequite within the range of public health, including as theydid the providing of means for escape from fire and the
feneing of dangerous machinery. General sanitary require-ments had reference to cleanliness, proper provision of closetaccommodation, air-space, ventilation, temperature, and thedrainage of floors where wet processes were carried on,though it appeared strange that there were no obligations as toefficient lighting. The investigations by certifying surgeons ofcases of anthrax, plumbism, mercury, phosphorus, or arsenicpoisoning contracted in a factory or workshop were of greatvalue, and had resulted in a supply of information which hadbeen of immense service in demonstrating the necessity forsupervision of the processes. Although much had been done toimprove the lot of the workers since the first Factory Actwas passed over a hundred years ago, the factory sanitariancould not yet rest on his oars. On the other hand, themedical officer of health must recognise the influence on the.general health of the community of the ill-effects which keptpace with, and which could not be dissociated from, industrial- occupations.
Dr. EDWARD C. SEATON referred to the work of Dr.
Whitelegge at the Home Office, and Dr. G. P. BATE con-sidered that one of the most important reforms of recentyears was the introduction of the conditional certificate ofemployment for children. Many children in an indifferentstate of health were better if working at a suitable employ-ment than running wild in the street. He pointed to thegreater efficiency of inspectors of factories, who were nowobliged to have a working knowledge of hygienic conditions.
Dr. A. GLEN PARK also spoke with approval of the con-ditional certificates, but regretted that he was not empowered
as a certifying surgeon to make a subsequent examination of achild for the purpose of ascertaining whether conditionshe had laid down, such as the provision of spectacles, hadbeen carried out. There was no doubt that these certificateshad encouraged certifying surgeons to allot suitable work toparticular children.
Dr. ALFRED GREENWOOD would like to see a closer
cooperation between medical officers of health and certifyingsurgeons, and suggested that the latter should have access tothe results of the medical inspections of school children.
Mr. F. E. FREMANTLE advocated courses of popular in-struction for workmen in the methods to be employed inpreventing accidents, and suggested that models of machineryproperly guarded should be placed in public museums.
Dr. J. H. KEAY supported this suggestion, and referred tothe fact that children who had been examined by a schoolmedical officer upon leaving school were frequently rejectedby the certifying surgeon on account of defective eyesight.
Dr. E. L. COLLIS urged the importance of medical officersof health taking more interest in conditions of employmentin special diseases, and referred with satisfaction to the workin this direction which had been done by Dr. Greenwoodand Dr. H. Scurfield. He emphasised the necessity for
investigating the invalidity of special industries andconsidered that danger in occupation was indicated more byinvalidity than by mortality.
Mr. HERBERT JONES, Dr. A. H. BYGOTT, Dr. SIDNEYDAVIES, Dr. W. BUTLER, and the PRESIDENT also took partin the discussion.
SOCIETY FOR THE STUDY OF INEBRIETY.
The Influence of Parental Alcoholism on the Physique andAbility of Offspring.
THE discussion on this subject, which was held at thewinter meeting of this society on Jan. 10th in the rooms ofthe Medical Society of London, was opened by Dr. T. B.HYSLOP, the President, in an address which we publishedlast week. Dr. Hyslop, it will be seen, emphasised the factthat recent study of the question had greatly increased thesense of its complexity, allowing that he personally underadvancing experience was more hesitant than formerly inconnecting the mental defects and disorders noted in theoffspring with the alcoholism of the parents. The real
question to be answered, he said, was, Does parentalalcoholism (of a pernicious kind)-apart from parentaldegeneracy, which, together with a tendency to alcoholism,is hereditable-influence the physique and ability of offspringat any age? He finished his address by saying that the conclu-sions arrived at by the Galton Laboratory School of Eugenicsand their critics dealt with part only of the general questionat issue, adding, "When further investigations shall havedemonstrated the inflaence of parental alcoholism on parentaldegeneracy, and the combined influence on the physique andability of offspring, we shall be better able to speak withauthority for the guidance of the community."
Mrs. SCHARLIEB expressed her general concurrence withDr. Hyslop’s views, and urged the necessity of keeping anopen mind on this question pending the result of fullerinquiry.
Sir VICTOR HORSLEY regretted that no representative ofthe Eugenics Laboratory had thought fit to attend themeeting, in view of Professor Karl Pearson’s recent incur-sion into this question. He referred to the damagingcriticisms to which Professor Pearson’s figures had beensubjected by the Cambridge economists, and mentioned thatas the result of a careful scrutiny of the Edinburgh CharityOrganisation Society’s report, utilised in the EugenicsLaboratory inquiry, he hoped in a few days to draw publicattention to other grave inaccuracies in Professor Pearson’sstatements.1 He emphasised the fact that in the biometricdata no evidence at all was offered to prove the alcoholism ofthe so-called alcoholic parents.
Dr. C. W. SALEEBY pointed out that Professor Pearsonhimself stated at the outset of his paper that there was adifference in the quality of the stock in the sober and in thedrinking parents investigated, and remarked that this factmust vitiate any conclusion as to differences in the quality ofthe offspring. To test the effect of alcoholism the comparison
1 See Brit. Med. Jour., Jan. 14th, p. 112.
165
-should be between like stocks. He referred to Forel’s views ojon blastophthoria, and suggested that there was ground for w
distinguishing an acute variety of this condition, as in cases II
where defect was supposed to depend on conception during Cdrunkenness, and a chronic variety as in ordinary cases of Cchronic alcoholism. He indicated the parallel instances of d
degeneracy induced by such poisons as lead and arsenic, s
The further evidence needed with reference to the whole v
problem would be best supplied by experiments on the lower r
animals. IDr. W. 0. SULLIVAN remarked that in the really scientific t
literature of the subject the alcoholism which was asserted to s
act injuriously on the offspring was chronic alcoholism, and the belief in its detrimental action rested on medical observa- ttions in which it was definitely ascertained that this chronic fintoxication really existed in the parent, and, further, that it fexisted before the conception of the child. Neither of these conditions was satisfied in the biometric data, where parents j were described as alcoholic on no better evidence than thefact that social workers thought that " they were drinkingmore than was good for them or their homes." If the bio-metricians really believed that these alcoholic parents weresuffering from chronic alcoholism, then they were assertingthat three-fifths of the adult male population of Edinburgh,as shown by their random sample, were chronic alcoholics-a figure absurd on the face of it. The latest study of thebiometricians on this question showed their want of first-handacquaintance with the facts of alcoholism. Otherwise theywould never have imagined that the inmates of inebriatereformatories were cases of "extreme alcoholism" or thatthe " intensity of their alcoholism could be measured bythe number of their convictions. This was due to thecommon illusion that drunkenness was the sole cause andtrue measure of alcoholism, whereas in fact the mostalcoholic individuals amongst police-court cases, from whichthe so-called inebriates were drawn, were precisely thosewho had fewest convictions.
Dr. E. CLAUDE TAYLOR entered a protest against thesuggestion in the biometric memoirs that inability to read orwrite was necessarily an evidence of mental deficiency whichshould render the individual so affected liable to be segre-gated for life.Canon HORSLEY and Mr. THEODORE NEILD also took part
in the discussion, and Dr. HYSLOP briefly replied.
EDINBURGH MEDICO-CHIRURGICALSOCIETY.
dThe Present Position of the Treatment of Plague.-Exhibition
.
of Cases and Specimens. iA MEETING of this society was held on Jan. llth, Dr.
BYROM BEAMWELL, the President, being in the chair. tDr. J. C. THOMSON read a paper entitled "The Present (
Position of the Treatment -of Plague." He began by i
emphasising certain points in reference to the general 1
management of a case of plague. While pneumonic cases, fortunately few in most epidemics, were virulently infectious through the emanations from the lungs, and must be dealt with in hospitals where due precautions against spread of the disease could be adequately provided, the results obtainedby the Second Indian Plague Commission (1905-1907) showedthat bubonic and septic semic cases might be safely treated inthe wards of ordinary hospitals, or in their own homes, pro-vided that measures against rats and their fleas be taken.Combined methods were recommended for the rapid localextermination of possibly infected rats : traps with baits
varying from day to day ; poisoning with phosphorus, 2.5 percent., or with barium carbonate, 25 per cent. ; birdlimespread on boards and baited like the traps; and Danysz’s
virus. For the destruction of fleas a most efficient pulicidein combination with a germicide was a mixture of equal pro-portions of petrol and cyllin, diluted with water 1 in 200.Contacts-i.e., persons who might presumably have beenexposed to the bites of fleas in the circumstances where infec-tion of the patient occurred-should be inoculated with Haff-kine’s prophylactic, which has maintained its reputation asthe safest and most efficient plague prophylactic, though anumber of others have in recent years been prepared. As to-the question of arrangements for disinfection during the
illness, these may be approximately the same as in the case
f enteric fever, except in cases of the pneumonic type,,hich being virulently infective from person to personequired the most complete measures possible in this respect.careful nursing of a case of plague was of the first importance.)n account of the marked tendency to heart failure in thislisease the recumbent position was essential so long as acutesymptoms lasted, and in delirious patients, who were oftenvildiy resistive, had not infrequently to be maintained bymechanical means. Points in reference to the nursing ofplague were described, attention being specially directedto close observation of the state of the bladder. Foodshould be of a bland character, liquid, and given in3mall quantity frequently, but after acute symptoms subsidedthe diet might be rapidly improved. Water should be freelyat disposal between the feeds, and should be frequentlyforced on acutely ill or delirious patients. The use of cardiacstimulants should be a routine practice in all cases of plaguefrom the very first. Great prostration occurred as a rule withina few hours from the commencement of the illness, and inthe earliest stages the debilitated heart needed support. Some-of the symptoms that were apt to prove urgent in plague werenext referred to-constipation, diarrhoea, high temperature,headache, delirium, insomnia, hæmorrhage—and theremedies found most useful in Dr. Thomson’s experience inHong-Kong were described. The treatment of the plaguebubo had been the subject of much discussion, but the con-sensus of opinion was against excision of it. A largeproportion of the buboes of patients who recover resolvedwithout suppuration. Injections of antiseptics into thebubo were of no value. The point of inoculation of plagueshould always be looked for, and, if discovered, should beattacked vigorously. Unfortunately, it was rarely to be found,in this according with experimental results in the monkey.But occasionally there might be seen on a limb, below thebubo, a papule with an inflamed base and a clear vesicle atthe top. the contents of the vesicle swarming with plaguebacilli in pure culture. Destruction of this papule by a thoroughdeep cauterisation with carbolic acid after crucial incisionwas usually followed by abortion of the illness and a rapidrecovery. The indolent ulcers that sometimes resulted fromthe buboes and the gangrenous skin areas, so-called carbuncles,occasionally met with, were manifestations of the generaldepression, and their treatment was on general principles.Convalescence from plague was usually slow, and the profoundenfeeblement frequently resulting from the illness, with themental and other sequelas that sometimes occur, had to bedealt with as individual cases demanded. Dr. Thomson thenproceeded to discuss a number of efforts made to find aspecific remedy for plague in the directions of antisepticdrugs, serum-therapy, and organo-therapy. He describedhis own attempts to introduce carbolic acid into the tissuesin sufficient quantity to delay the proliferation of the plaguebacillus and allow the natural reaction against the organismtime to assert itself. The use of 80 grains a day in a series
tof 204 cases seemed of little value, the plague hospitalmortality being 76- 5 per cent., only slightly less thanL the Hong-Kong average. But in another epidemic 144-
, grains daily in a series of 143 cases gave a mortality5 rate of only 36 4 per cent., this result, however, beingt obtained in the second half of the epidemic when the3 disease was normally less virulent. In the earlier half of the1 same epidemic oil of cinnamon had been used, but proved1 valueless. Further experience in Hong-Kong confirmed Dr.!l Thomson’s belief that carbolic acid, while in no sense a.
- specific remedy, was of undoubted value in the treatment of.. plague when given in massive doses. Trials made with other antiseptics had been disappointing. The position asis regards the serum treatment of plague was pretty much that!r described in reference to antiseptics. Most unequal results-e had been obtained by different observers, among different.
races, in different epidemics. In comparing results-le it was important to note that European races showed)- a much larger proportion of recoveries, irrespective
of treatment. In a series of 94 cases treated by Dr.;n Thomson in Hong. Kong with serum supplied by thec- Pasteur Institute in Paris the mortality was 85 per cent.,EE- and further trials gave scarcely better results. In Bombayas Choksy, using the same serum, had in a series of 200 cases aa mortality of 63 5 per cent., while in 200 control cases theto- mortality was 74 per cent., showing a gain of 10 5 perhe cent. On the other hand, in Oporto 140 cases were treated,.se with a mortality of only 14.78 per cent. ; and in Brisbane
